The terms of reference for the inquiry must be as wide as possible, writes Conall Ó Fátharta.

THE decision of the Government to delay the terms of reference for the mother-and-baby-homes inquiry until the autumn should have raised a few more eyebrows than it did.

As anybody campaigning for justice on any issue here will tell you, the terms of reference for any investigation are everything. After all the platitudes about truth and transparency fade from newspapers and airwaves, what you are left examining is the small print of what will and what will not be open for inquiry and investigation.

In his brief time as children’s minister, Charlie Flanagan was a breath of fresh to campaigners for justice for women who went through Ireland’s infamous mother-and-baby homes.

By promising a full and wide- ranging inquiry looking at everything from infant deaths to illegal adoptions, he raised the hopes of a long-ignored community dramatically. They were told they would see the terms of reference before the summer.

However, after just two months in the job, Mr Flanagan was moved into the foreign affairs portfolio and James Reilly was moved into the children’s ministry.

The interdepartmental group on mother-and-baby Homes seemed to dash any hopes of a wide ranging inquiry. Then we were told that the terms of reference would now have to wait until the autumn.

Campaigners could be forgiven for thinking that perhaps the delay was a result of trying to narrow the scope of the inquiry. A case of here we go again.

The revelation in this newspaper that an official investigation carried out by the Cork County Medical Office in 1943 found a child death rate of 68% in the notorious Bessborough mother-and-baby-home should serve as a reminder to Government that the terms of reference should be as wide-ranging as permissible. The issues at stake here are just too serious.

A massive trawl of all available archival material is needed simply to ascertain just how many children may have died in these institutions.

Given the traffic from county homes and to Magdalene laundries, these institutions also have to be included in any inquiry. All these institutions are linked and leaving any out will only tell us one thing — the State still doesn’t want the truth to come out.

Not only does such a level of infant mortality rate of 68% shock modern sensibilities, it also shocked 70 years ago.

The number of deaths occurring in Bessborough and the health of children being boarded out to foster-parents in the 1940s was on the Government’s radar to such an extent that a local government department inspector felt compelled to report it to the local authority in Cork.

The inspector, Alice Litster, reported a child death rate at the mother-and-baby-home in 1943 of a staggering 61%.

It wasn’t the first time the issue of high infant mortality had been an issue of concern for the State.

In her book Mother and Child: Maternity and Child Welfare in Ireland, 1920s-1960s, Lindsey Earner-Byrne recorded that, four years earlier in 1939, the annual inspector’s report found an infant mortality rate in Bessbrorough of 47%. By the time Ms Litster was looking into the home in 1943, things had clearly deteriorated.

Archival material uncovered by the Irish Examiner shows that two separate reports were prepared for the county manager in 1943 and 1944 on foot of Ms Litster's concerns. Both make for stark reading.

The first confirms an investigation was carried out by Assistant Medical Officer of Health Dr O’Briain into the home and its high infant mortality rate.

“I investigated this Home and figures obtained were Deaths — 68% (Sixty eight) of the births,” stated the report. “Diagnosis in most of these cases was Debility, some were given as gastroenteritis and a small number as prematurity. Most of the deaths were from 2-3 weeks to 3 months. This is the period they leave the Maternity Hospital for the Home.”

Later in the report, the chief medical officer of health Robert Condy said the matron of the home had offered an explanation for such a high death rate.

“The Matron stresses the high proportion of infants who are born in this institution in a state of debility, and the small number of cases in which it is possible to secure breast feeding,” said the report.

“All births in the Institution are of an illegitimate character, and there is frequently a lack of interest in the child’s welfare on the part of the mother concerned. These factors all appear to contribute towards the high rate of Infant Mortality obtained.”

It also noted that the vast majority of deaths occurred due to debility in the neo-natal period and that if these deaths were to be prevented “the most skilled medical and nursing attention is required”.

The question of whether or not the “most skilled medical and nursing” attention pertained there was the subject of a second report prepared by Dr Condy.

In it, he reveals that despite being subjected to “periodical inspections” under the Maternity Homes Act, Bessborough nonetheless had a “habitual high rate of Infant mortality”.

Regarding the qualifications of the staff who were running the home, the report is withering.

In the maternity section of the home, which housed 26 beds, four staff were employed to look after the women — one nun who was a registered nurse, two lay nurses, and a lay person without any medical qualifications of any kind.

However, crucially considering Dr Condy’s concern over children dying in the early stages of life at Bessborough, just one staff member had a midwifery qualification and none had any special training in dealing with infants.

“There is therefore only one Nurse in this section who possesses the CMB [Central Midwives Board] Certificate, and no member of the Nursing staff has undergone any special training in infant hygiene and dietetics,” said the report.

Remarkably, given that death rates of over 45% were being recorded four years earlier, the staff in this section had been all been employed at the home for more than a decade. One woman, a Ms Sweetman, possessed no qualifications at all to work in such a position. “Miss Sweetman. No medical or nursing qualifications or hospital experience. Employed for the past eleven years in Bessboro’ as general Assistant,” stated the report.

In the infant home section, which contained 70 beds, the three nuns employed to care for the women did not have a nursing qualification between them, not to mention any qualifications in midwifery or infant care.

One had been sent to Bessborough from the order’s other mother-and- baby home and had been there for a year. Another nun had been working in the home for two years, while the longest-serving nun had been employed for 14 years.

While some had experience in hospitals, none had any qualifications, with one nun, Sr Conletham possessing no experience of any kind.

“Sr Conletha in charge of sub-section two. Not a State Registered Nurse. No previous training or experience or Hospital experience. Has been two years in Bessboro’,” stated the report.

Dr Condy also raised other concerns — namely that, in three cases, children had been returned by foster parents. In one case the child was over two years old, while in another case the child had to be rushed to hospital and appears to have then gone missing.

“A baby six weeks old, returned by foster parent after three weeks. This child, upon return, is stated to have had congestion of the lungs and was immediately transferred to the Victoria Hospital. Present whereabouts unknown,” stated the report.

In another case, a child over two years old was due to be returned to Bessborough by a foster mother simply because the child’s crying disturbed the sleep of the foster father. “A baby of over two years of age returned by foster parent in about ten day’s time, the only apparent reason that the child disturbed the husband of the family by crying at night. The child is at present a very healthy looking specimen,” stated the report.

Dr Condy also took issue with the fact that the nuns were boarding out children at just a few weeks old — something deemed ethically wrong even back in the 1940s.

“I am informed that the age at which infants are discharged from this section for boarding-out, averages around one year but infants have been boarded out at as early an age as six weeks,” he wrote. “It would seem undesirable that infants should be separated from their mothers at such an early period.”